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Acute immune thrombocytopenic purpura post first dose of COVID-19 vaccination
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  • Published on: 28 August 2021
    The impossible choices we ask patients to make
    • oscar,m jolobe, retired geriatrician British Medical Association. Also a member, but not an affilliate of the Manchester Medical Society

    This remarkable account of the successful treatment of two cases of Vaccine Induced Thrombosis with Thrombocytopenia(VITT) aged 86 and 38, respectively(1), is also remarkable for the fact that the second patient, aged 38, did not qualify for receipt of a vaccine other than the AstraZeneca vaccine. She failed to qualify because , either in April or in May 2021, Public Health England and Joint Committee on Vaccination and Immunisation(JCVI) issued a directive which stated "JCVI currently advises that it is preferable for adults aged < 30 years without underlying health conditions that put them at higher risk of severe COVID-19 disease, to be offered an alternative COVID vaccine, if available"(2)(3). However, this recommendation did not apply to people aged 30-40(the age group of patient )(1), notwithstanding the fact that, on the 6th May 2021, headlines in the Independent had declared "Under 40s to be offered alternative to AstraZeneca vaccine over increased clot risk"(4).

    By the 30th July 2021, 411 cases of VITT had been documented, including 73 fatalities. In the age group 30-39 there were 51 cases of VITT, including 11 deaths(5). By the time this patient had been vaccinated, however, the BNT162b2(Pfizer) vaccine, and probably also the mRVA-1273(Moderna) vaccine must have been available as potential alternatives to the AstraZeneca vaccine. The Pfizer vaccine is 95% effective in preventing Covid-19(95% credible interval, 90.3 to 97.6).

    T...

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    Conflict of Interest:
    None declared.